Provider Demographics
NPI:1932164043
Name:MCCLOSKEY, BRYAN M (ATC)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:M
Last Name:MCCLOSKEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W PENNSYLVANIA AVE
Mailing Address - Street 2:#2
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2521
Mailing Address - Country:US
Mailing Address - Phone:610-269-3793
Mailing Address - Fax:
Practice Address - Street 1:WEST CHESTER HENDERSON HIGH SCHOOL
Practice Address - Street 2:400 MONTGOMERY AVENUE
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380
Practice Address - Country:US
Practice Address - Phone:484-431-2227
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0031672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer